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File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

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1.	PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Union Star
Inc Town:  
City:
No.
St.
Ward
Registration District No.:  Reg. Dist. No. 5309
Primary Registration District No:  
File No.  17194
Registered No:  5
2.	FULL NAME:  Allie Gilland
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  Female
4.	COLOR OR RACE:  White
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Single
6.	DATE OF BIRTH:  Jan 2, 1893
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  18 yrs  7 mos  1 ds
8.	OCCUPATION (a.) Trade, profession or particular kind of work:
(b.)  General nature of industry business or establishment which employed:  needlework
9.	BIRTHPLACE:  Mystic, Ky
10.	NAME OF FATHER:  Noel L. Gilland
11.	BIRTHPLACE OF FATHER:  Indiana
12.	MAIDEN NAME OF MOTHER:  Mary ?. Lowe
13.	BIRTHPLACE OF MOTHER:  Indiana
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  C. W. Bru
(Address)  Lodeburg, Ky
15.	Filed  July 4, 1911  Stewart
REGISTAR:  R. A. Shellman  Stephensport Dist.
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:July 3, 1911
17.	I HEREBY CERTIFY, That I attended deceased from (date):  June 1809 to July 3rd, 1911
That I last saw him/her alive on (date):  June 7, 1911
And that death occurred on the date stated above at (time AM/PM):  7 pm
THE CAUSE OF DEATH was as follows:  General Necrosis

(Duration):  Years:  2     Months:  10     Days:  20
Contributory
(Duration)   Years:        Months:         Days:
Signed (M.D.):  T. J. Hendrick M.D.
Date:  July 3, 1911
Address:  Webster, Ky
18.	LENGTH OF RESIDENCE (For Hospitals, Institutions, Transients, or Recent Residents)
At place of death (yr, mo, da.):
In the State (yr, mo, da):
Where was disease contracted,  if not at place of death?
Former or usual residence:
19.	PLACE OF BURIAL OR REMOVAL  Walnut Grove, Ky
DATE OF BURIAL:  July 5, 1911
20.	UNDERTAKER:  W. J. Schopp
ADDRESS:  Stephenspport, Ky

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Copyright.  All rights reserved.
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